Laser Guidance Improves Accuracy and First-pass Success in CT-Guided Interventions: A Multicenter Randomized Trial

Area of Science:

• Medical Imaging and Interventional Radiology
• Surgical Navigation Technologies

Background:

• Freehand computed tomography (CT)-guided percutaneous needle puncture accuracy is limited, particularly for small or challenging thoracoabdominal lesions.
• Gantry-mounted laser navigation offers a cost-effective alternative to electromagnetic or robotic systems by projecting planned trajectories onto patients.

Purpose of the Study:

• To evaluate if laser guidance enhances the accuracy and efficiency of CT-guided punctures compared to the conventional freehand technique.

Main Methods:

• A multicenter randomized trial involving 170 adults with thoracic or abdominal lesions (≥10mm) was conducted.
• Participants were assigned to either laser-guided intervention (n=85) or freehand control (n=85).
• Primary endpoint: successful lesion access with ≤2 needle repositionings; secondary endpoints: needle-tip error, CT scan count, puncture time, and complications.

Main Results:

• Laser guidance significantly increased successful puncture rates (91.4% vs 37.3%, P<.001) and reduced mean targeting error (2.1±0.9 mm vs 3.5±0.8 mm, P<.001).
• Fewer confirmatory CT scans were needed with laser guidance (4.1±2.1 vs 4.9±2.4, P=.014).
• Puncture duration and major complication rates were similar between groups.

Conclusions:

• Gantry-mounted laser guidance substantially improves first-pass success and accuracy for CT-guided thoracoabdominal punctures.
• It provides an efficient, low-cost alternative to freehand techniques without increasing procedure time or risk.